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Vancomycin for prophylaxis against sepsis in preterm neonates.
A P Craft1, N N Finer, K J Barrington
1Pediatrics, University of California, San Diego, 200 W Arbor Dr, San Diego, California 92103-8774, USA. nfiner@ucsd.edu
The Cochrane Database of Systematic Reviews
|May 5, 2000
Summary
Prophylactic vancomycin reduced sepsis in preterm infants but showed no significant benefits in mortality or toxicity. Routine use is not recommended due to limited clinical advantages and theoretical risks of resistance.
Area of Science:
- Neonatal Medicine
- Infectious Diseases
- Pharmacology
Background:
- Late-onset sepsis affects up to 50% of very low birth weight infants.
- Coagulase-negative staphylococcus (CoNS) is the most common pathogen.
- Vancomycin prophylaxis efficacy in preterm neonates is under review.
Purpose of the Study:
- Evaluate vancomycin prophylaxis safety and efficacy in preterm neonates.
- Assess impact on sepsis, mortality, length of stay, and vancomycin resistance.
- Determine effects on vancomycin toxicity and total exposure.
Main Methods:
- Systematic review of randomized controlled trials.
- Searches included Medline, HealthStar, and EMBase databases.
- Compared vancomycin prophylaxis versus no prophylaxis in preterm infants.
Main Results:
- Prophylactic vancomycin decreased neonatal nosocomial sepsis and CoNS sepsis.
- No significant differences in mortality, length of stay, or vancomycin toxicity.
- Insufficient evidence on the development of vancomycin-resistant organisms.
Conclusions:
- Low-dose prophylactic vancomycin reduces neonatal nosocomial sepsis.
- Methodological limitations may have influenced sepsis rates in treated groups.
- Routine vancomycin prophylaxis is not currently recommended due to limited benefits and unproven risks.